Â鶹´«Ã½Ó³»­

Â鶹´«Ã½Ó³»­

Explore the latest content from across our publications
Join The Â鶹´«Ã½Ó³»­

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

Serum RPR negative case of neurosyphilis in an AIDS patient with bilateral recurrent artery of Heubner infarcts
Infectious Disease
Infectious Disease Posters (7:00 AM-5:00 PM)
039

To report a case of a 47-year-old male with AIDS found to have multifocal strokes including bilateral recurrent artery of Heubner infarcts due to meningovascular neurosyphilis despite a negative serum RPR.

Meningovascular neurosyphilis occurs in 3% of all patients with syphilis and manifests as a meningoencephalitic syndrome with cerebrovascular events. The majority of patients affected by meningovascular neurosyphilis are under 50-years-old, and as such it is standard clinical practice to use serum RPR as a screening test for stroke in the young. However, serum RPR can be false-negative in certain cases.  
NA
A 47-year-old Caucasian male with a past medical history of HIV and alcohol/drug use was found down in his home with last known normal ten days prior. On admission, BP was 178/105, HR 135, and NIHSS 12 for confusion and right hemiplegia. NCCT Head showed bilateral basal ganglia hypodensities, initially interpreted by radiology as hypoxic ischemic injury. MRI brain revealed infarcts of varying ages involving bilateral caudate heads, genu of corpus callosum, anterior commissure, left medial medulla with scattered leptomeningeal enhancement along the inferior frontal lobe and basal cistern. MRA showed moderate P2 narrowing adjacent to leptomeningeal enhancement. Serum studies were notable for a CD4 count of 88, non-reactive RPR, negative COVID-19, and unremarkable basic stroke work-up including TTE with bubble and telemetry. Alternate serum treponemal tests were not sent prior to LP. CSF showed lymphocytic pleocytosis (165 with 99% lymphs) with elevated protein of 78, reactive VDRL and FTAA with a VDRL titer 1:4. He was treated with IV penicillin and aspirin 81mg daily.

Serum RPR may be an inadequate screening tool for stroke in the young, especially in the setting of AIDS. If clinical suspicion is high for meningovascular neurosyphilis, then further diagnostic work-up should be pursued with alternate serum treponemal studies and/or CSF studies.
Authors/Disclosures
Madeline L. Singer, MD
PRESENTER 		Dr. Singer has nothing to disclose.
Supreet Kaur, MD Dr. Kaur has nothing to disclose.